Infiltec Seismometers     FAX ORDER FORM     http://www.infiltec.com/seismo

If you want to pay by credit card or Paypal, please print out this form, fill it out, and fax it to David Saum, 
Infiltec, FAX: 703-671-9350, PHONE 703-820-7696. You do not have to include a cover page with your fax. For more 
product information, see http://www.infiltec.com/seismo

We will inform you when your order is ready to ship, and then you should reconfirm that you want the shipment.  we 
When we get your confirmation, we will ship and bill your credit card, or you can make a payment to Paypal before 
we ship.


YOUR SEISMOMETER ORDER:

Quantity      Product                                                                     Price   Subtotal
               LONG PERIOD (1.0 Hz low pass, designed for long period sensors like Lehman's)    
________    QM-1.0-3704 assembled/tested pcb, pickup coil, metal enclosure, 370-4 magnet   $144    ________
________    KQM-1.0-3704 kit: pcb, components, pickup coil, metal enclosure, 370-4 magnet   $99    ________

               SHORT PERIOD (4.5 Hz low pass, designed for L-15B Mark Products 4.5 Hz Geophone)  
________    QM-4.5-L15B assembled/tested pcb, metal enclosure, 10' cable, L-15B geophone   $159    ________
________    KQM-4.5-L15B kit: pcb, components, metal enclosure, 10' cable, L-15B geophone  $114    ________

               STRONG MOTION (4.5 Hz low pass, designed for single axis ADXL103 accelerometer)
________    QM-4.5-ADXL103 assembled/tested pcb, enclosure, 10' ft cable, mounted ADXL103  $149    ________
________    KQM-4.5-ADXL103 kit: pcb, components, enclosure, 10' ft cable, mounted ADXL103 $104    ________
________    QM-L-15 Optional 4.5 Hz geophone dual purpose use of the QM-4.5-ADXL103         $40    ________
________    QM-ADXL103 Optional accelerometer chip mounted on carrier board for QM-4.5      $30    ________


               OPTIONAL SERIAL EXTENSION CABLES FOR REMOTE INSTALLATIONS
________    QM-02712 Extension DB9(M/F) Cable (10 ft)                                       $10    ________
________    QM-09452 Extension DB9(M/F) Cable (25 ft)                                       $20    ________
________    QM-09453 Extension DB9(M/F) Cable (50 ft)                                       $30    ________
________    QM-17612 Extension DB9(M/F) Cable (100 ft)                                      $50    ________

               SHIPPING
________    Within USA - USPS Priority mail with insurance for one seismometer             $10     ________
________    Outside USA - USPS Global Priority Mail with insurance for one seismometer     $25     ________

                                   
                                                                                       TOTALS  
                                                                                Product Total      ________
                                                   5% sales tax for VA customers                   ________
                                                   
                                                                                           Total   ________

* NOTE: Shipping for one seismometer is a small box about 1 kilo (2.2 lb) in weight. 
Also note that for international orders, you are responsible for any import duty and taxes. 

        YOUR SHIPPING ADDRESS:
NAME: 		
COMPANY:	
STREET1:	
STREET2:	
CITY:		
STATE:		
POSTAL CODE:	
COUNTRY:	
PHONE:		

         YOUR CREDIT CARD: 
TYPE:        (VISA) (MASTERCARD) (AMEX)
CARD NUMBER:	
ISSUING BANK:	
NAME ON CARD:	
CARD EXPIRES:
SECURITY CODE:	
SIGNATURE:	
TODAYS DATE:	

We also accept Paypal to Dsaum@infiltec.com

        AVAILABILITY: 
Orders may require 2-4 weeks to build and test. We will not bill you until we ship. 

        OUR CONTACT INFORMATION:
David Saum, Infiltec
PO Box 8202 (physical address: 5613 Leesburg Pike, Suite 53)
Falls Church, VA 22041-8202, USA
phone:  703-820-7696, fax:  703-671-9350, email:  DSaum@infiltec.com

__________      FAX COMPLETED FORM TO 703-671-9350      _______     March 15, 2006 version